RESUMO
BACKGROUND: Pediatric traumatic amputations are devastating injuries capable of causing permanent physical and psychological sequelae. Few epidemiologic reports exist for guidance of prevention strategies. The objective of this study is to review the recent trends in pediatric traumatic amputations using a national databank. METHODS: A review of all pediatric (age, 0 to 17 y) amputee patients was performed using the National Trauma Data Bank from 2007 to 2011. Data including demographics, location of amputation, and mechanism of injury were analyzed. RESULTS: In the analysis 2238 patients were identified. The majority of amputations occurred in the youngest (0 to 5 y) and oldest (15 to 17 y) age groups with a 3:1 male to female ratio. The most common amputation locations were finger (54%) and toe (20%). A caught between mechanism (16.3%) was most common overall followed by machinery, powered lawn mowers, motor vehicle collisions, firearms, and off-road vehicles. Males were statistically more likely to have an amputation and lawnmower injuries were statistically associated with lower extremity amputations in children 5 years old and below. Motor vehicle injuries were the most common cause of adolescent amputations. Firearm-related amputations occurred predominantly in adolescents, whereas off-road vehicle amputations occurred in all ages. CONCLUSIONS: Common trends in pediatric amputations are relatively unchanged over the last decade. Young children sustain more finger amputations from a caught between objects mechanism, whereas adolescents sustain serious amputations from higher energy mechanisms such as firearms-related and motor vehicle-related injuries. Lawnmower-related amputations continue to most significantly affect younger children despite increased public awareness. Improved prevention strategies targeting age and mechanism-related trends are necessary to prevent these costly and debilitating injuries. LEVEL OF EVIDENCE: Level IV.
Assuntos
Amputação Traumática/epidemiologia , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Fatores Etários , Amputação Traumática/etiologia , Amputados , Criança , Serviços de Saúde da Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores Sexuais , Estados Unidos/epidemiologiaRESUMO
PURPOSE: To describe the injuries due to fireworks use in Colombia during the period 2008-2013 and to identify factors associated with hospitalization and death due to this cause. METHODS: A descriptive study from surveillance data was carried out. Incidence rates and relative risks were calculated. The incidence rate trend was modeled with a joint point regression model. Multivariate logistical models were implemented to identify the associated factors with hospitalization and mortality due to firework injuries. RESULTS: A total of 6585 people were reported to be injured by fireworks during the 2008-2013 period. An upward trend in the incidence rate during this period was observed, with an annual percentage of change of 28% (95% CI 27.7-28.3) during 2008-2011 and 3.5% (95% CI 3.0-3.9) during 2011-2013. The factors associated with hospitalization were injury occurrence at the workplace (odds ratio (OR) 2.62, 95% CI 1.97-3.47), storage (OR 2.40, 95% CI 1.54-3.73), transport (OR 1.63, 95% CI 1.20-2.21), multiple trauma (OR 1.49, 95% CI 1.31-1.70), and injury occurrence at home (OR 1.26, 95% CI 1.07-1.50). The factors associated with mortality were storage (OR 19.52, 95% CI 4.62-82.44), transport (OR 13.37, 95% CI 3.29-54.3), injury occurrence at the workplace (OR 4.88, 95% CI 1.69-14.13), and ethnicity (OR 3.37, 95% CI 1.12-10.12). CONCLUSION: These results provided information for revising the public policies and intersectorial interventions to reduce the avoidable burden due to firework injuries at all times and not just during the high injury occurrence season.
Assuntos
Acidentes Domésticos/estatística & dados numéricos , Amputação Traumática/epidemiologia , Queimaduras/epidemiologia , Contusões/epidemiologia , Explosões , Lacerações/epidemiologia , Traumatismo Múltiplo/epidemiologia , Traumatismos Ocupacionais/epidemiologia , Acidentes Domésticos/prevenção & controle , Adolescente , Adulto , Amputação Traumática/prevenção & controle , Queimaduras/prevenção & controle , Criança , Pré-Escolar , Colômbia/epidemiologia , Contusões/prevenção & controle , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Lactente , Recém-Nascido , Lacerações/prevenção & controle , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/prevenção & controle , Análise Multivariada , Traumatismos Ocupacionais/prevenção & controle , Razão de Chances , Política Pública , Local de Trabalho , Adulto JovemRESUMO
OBJECTIVES: To report the incidence of symptomatic heterotopic ossification (HO) in a defined civilian amputee population, describe its characteristics, and compare these findings to published data in military amputees. DESIGN: Retrospective chart analysis from July 1998 to July 2009. SETTING: Ambulatory amputee clinic within a large university medical center. PARTICIPANTS: Adults with lower limb amputation (N=158). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Patients with symptomatic HO confirmed by radiographs. RESULTS: A total of 261 patients were evaluated; 158 met inclusion criteria, with 59% having traumatic etiology, 18% vascular etiology, 22% infection, and 1% tumor. Symptomatic HO was diagnosed in 36 (22.8%) patients, and 94% patients had mild HO on radiographic scoring. Rate of HO in amputations related to trauma was not increased compared with those of other etiologies. Surgical resection of the ectopic bone was required in 4 (11%) patients. CONCLUSIONS: HO is seen commonly after civilian lower limb amputation regardless of etiology. The prevalence was less than that observed in previous reports from military populations. This is the first report estimating the prevalence of HO in adult civilian amputees.
Assuntos
Amputação Cirúrgica/estatística & dados numéricos , Amputação Traumática/epidemiologia , Militares/estatística & dados numéricos , Ossificação Heterotópica/epidemiologia , Amputação Cirúrgica/efeitos adversos , Amputação Traumática/complicações , Membros Artificiais/efeitos adversos , Membros Artificiais/estatística & dados numéricos , Causalidade , Estudos de Coortes , Comorbidade , Feminino , Humanos , Incidência , Extremidade Inferior/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/cirurgia , Pennsylvania , Prevalência , Radiografia , Estudos RetrospectivosRESUMO
CONTEXTO: Vivemos num período de epidemia do trauma. A amputação de indicação traumática incide em uma população jovem e economicamente ativa com repercussão onerosa no âmbito socioeconômico, tornando-se um problema de saúde pública. OBJETIVOS: Conhecer a casuística de amputações traumáticas realizadas na Santa Casa de Campo Grande-MS, entre 2005 e 2008. MÉTODOS: Estudo de prevalência, descritivo, longitudinal e retrospectivo. Amostragem de conveniência, realizada com revisão sistemática de prontuários de pacientes submetidos a amputações de membros inferiores e/ou superiores cuja indicação foi trauma incompatível com reconstrução. Foram excluídos os pacientes que já chegaram amputados no pronto-socorro. Avaliaram-se nível de amputação, faixa etária, sexo e escala do sistema MESS para indicação de amputação traumática. Utilizaram-se o teste quiquadrado e o teste exato de Fisher, considerando um intervalo de confiança de 95%. RESULTADOS: Foram realizadas 108 amputações no período, na faixa etária de dois anos a 78 anos, com média de 36,7 ± 12 anos e mediana de 35 anos. Houve predomínio do sexo masculino em 72% da casuística. O nível de amputação mais executado foi de amputações menores (pododáctilos e quirodáctilos). A causa mais frequente foi lesão decorrente de acidente de trânsito. CONCLUSÕES: As amputações traumáticas atingiram uma população jovem e produtiva, conforme corroborado pela literatura, com predomínio de acidentes de trânsito com lesões ortopédicas e neurológicas associadas.
BACKGROUND: We live in a period of epidemic of trauma. Amputation due to trauma affects a young and economically active population, with costly socioeconomic consequences, becoming a public health problem. OBJECTIVE: To investigate the series of amputations performed at Santa Casa de Campo Grande Hospital between 2005 and 2008. METHODS: Prevalence, descriptive, longitudinal and retrospective study. Convenience sampling was used to conduct a systematic review of medical records of patients undergoing lower and/or upper limb amputations whose diagnosis was trauma incompatible with reconstruction. Patients who arrived at the emergency department with amputated limbs were excluded from the study. We assessed the level of amputation, age, sex, and MESS score for amputation after trauma. The chi-square test and Fisher's exact test were used considering a 95% confidence interval. RESULTS: One hundred and eight amputations were performed in the period. Patients' two to 78 years; mean age was 36.7 ± 12 years, and median age was 35 years. Most patients were males (72%). The most frequent level of amputation was minor amputations (toes and fingers). The most common cause of amputation was injury resulting from traffic accidents. CONCLUSIONS: In agreement with the literature, trauma amputations affect a young and productive population, with prevalence of traffic accidents with associated orthopedic and neurological injuries.
Assuntos
Humanos , Masculino , Adulto Jovem , Idoso , Amputação Traumática/epidemiologia , Extremidade Inferior/lesões , Saúde Pública/tendências , Brasil/epidemiologia , Estudos Transversais/métodosRESUMO
The purpose of the study was to describe the demographics, the causes of amputations, the amputation levels, the clinical outcomes, the durability of prostheses in unilateral lower limb amputee among workers entitled to non-state related work insurance, the ACHS, Chile, between 1974 and 2001. It was a retrospective descriptive study based on selected clinical files. One hundred files, with the minimal data required, were selected with a diagnosis of traumatic lower limb amputation, the levels ranging from Boyd's foot amputation to hip disarticulation, as defined by the Occupational Accidents Act from 1974 to December 2001. The mean age was 35.5 years, 96% were males, with an average follow-up of 7.7 years. In 50% of the cases the education level did not exceed elementary school. Ninety-eight percent were blue collar workers. The traumatic injury resulting in amputation took place during work in 89% of the cases the main causes being crushing injury (50%), traffic accident (19%), run over by car (14%) and burns (6%). The most common amputation levels were trans-femoral (40%) and trans-tibial (47%). Amputations were performed within the first 24 h in 49% of the cases. The hospitalization stay reached 8 weeks in 56.7%. Early complications were dehiscence (9.4%), superficial infection, (14.6%) and deep infection (26%). Late complications detected were soft tissue lesions (34.1%), exostosis (3.6%), painful neuroma (12.5%) and phantom limb pain (12.5%). Prostheses durability was on average 3 years. The average period to resume work was 1 year for 60% of the cases.
Assuntos
Acidentes de Trabalho , Amputação Traumática/epidemiologia , Amputação Traumática/terapia , Amputados/psicologia , Amputados/estatística & dados numéricos , Adolescente , Adulto , Amputação Traumática/fisiopatologia , Membros Artificiais , Chile/epidemiologia , Feminino , Humanos , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Resultado do Tratamento , Caminhada/fisiologiaRESUMO
The author performed 85 ambulatory digital replantations between 1994 and 1999. Ages varied from 15 to 33 (average 24), with a prevalence of the male sex. The main mechanism of injury was guillotine (60%), followed by avulsion (40%). Surgical procedure lasted approximately four hours. Patients remained in the hospital for eight hours maximum, period in which they were closely observed. Patients received printed instructions about the risks of arterial and venous thrombosis and how they could observe it themselves. A protocol was established to evaluate the results. Patients were instructed to call the surgeon as soon as any change--mainly in color--was noticed. Based on a phone call, twenty patients were evaluated in the immediate postoperative period (24 initial hours) to rule out circulatory problems. In fifteen patients, thrombosis was noted in the replanted segment. Twelve of these patients (14.11%) lost the replanted digit completely. The loss of the replanted segment was not observed in the group of patients that did not call the surgeon.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Amputação Traumática/cirurgia , Traumatismos dos Dedos/cirurgia , Microcirurgia/métodos , Reimplante/métodos , Adolescente , Adulto , Distribuição por Idade , Procedimentos Cirúrgicos Ambulatórios/normas , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Amputação Traumática/epidemiologia , Feminino , Traumatismos dos Dedos/epidemiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Microcirurgia/normas , Microcirurgia/estatística & dados numéricos , Educação de Pacientes como Assunto/métodos , Assistência Perioperatória/métodos , Prevalência , Estudos Prospectivos , Reimplante/normas , Reimplante/estatística & dados numéricos , Distribuição por Sexo , Fatores de Tempo , Resultado do TratamentoAssuntos
Amputação Traumática/diagnóstico , Amputação Traumática/epidemiologia , Amputação Traumática/etiologia , Biópsia por Agulha , Causalidade , Doença Aguda , Doenças do Sistema Nervoso Periférico/complicações , Emigração e Imigração , Hanseníase/complicações , Hanseníase/diagnóstico , Serviço Hospitalar de Emergência , Traumatismos da Mão/diagnóstico , Traumatismos da Mão/epidemiologia , Traumatismos da Mão/etiologiaRESUMO
Os autores analisaram 1.000 casos de lesöes traumáticas da mäo em acidentes do trabalho, no período de setembro de 1986 a fevereiro de 1989, abordando suas características e epidemiologia em nosso meio. Os resultados, de acordo com os itens analisados, revelam que a maioria absoluta dos acidentados é do sexo masculino, entre 20 e 45 anos de idade, sendo o carpinteiro o profissional mais atingido. Os equipamentos mecânicos säo os principais agentes causadores, destacando-se a serra circular (16,5 por cento). A maioria das lesöes é aberta e ocorre no meio urbano. Näo houve diferença significativa entre a mäo mais atingida e a dominância. Os dedos foram as estruturas mais atingidas (79 por cento). O indicador e o médio foram lesados quase que com a mesma freqüência. O indicador foi o mais freqüentemente amputado (28 por cento). Quarenta por cento dos acidentados só foram encaminhados ao especialista mais de 90 dias após a lesäo e 5 por cento após um ano. Setenta e três por cento dos acidentados receberam alta antes de 90 dias, quando tratados no Serviço da Mäo. Dos 1.000 casos analisados, 55,1 por cento das lesöes evoluiram para seqüelas, sendo a mäo dominante a mais atingida. Conclui-se que as lesöes traumáticas da mäo constituem problema de grande impacto social e econômico para a empresa, instituiçöes previdenciárias e principalmente para o paciente, cujo tratamento inicial especializado é de suma importância para o prognóstico destas lesöes